Treatment for Uterine Cancer

At the Saint John’s Cancer Institute, personalized care is our top priority employing a multi-disciplinary approach and post-treatment care to help you beat uterine cervical. We treat the entire person and not just the disease, creating a more supportive environment. Our care teams are ready to support you.

Uterine cancer refers to cancer that begins in the uterus, a pear-shaped organ in a woman’s pelvis where fetal development occurs. There are two main types of uterine cancer: Endometrial Cancer, which is the most common type and originates in the endometrium, and Uterine Sarcoma, which is rarer and starts in the muscles of the uterus. For symptoms and risk factors, please see Conditions: Uterine Cancer.

Treatment for uterine cancer typically involves a combination of approaches, tailored to the individual’s specific condition and overall health. Here are some common and innovative treatment options:

Surgery for Uterine Cancer

Surgery is often the first line of treatment for uterine cancer. The most common surgical procedure is a total hysterectomy, which involves removing the uterus, cervix, and sometimes the fallopian tubes and ovaries. In some cases, lymph nodes in the pelvis and around the aorta may also be removed to check for cancer spread. For early-stage cancers, surgery alone may be curative.

At Saint John’s Health Center, surgery is often performed using minimally invasive robotically assisted technology and typically involves a hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of uterus, cervix, and additional tissue along the sides of the uterus and cervix).  The use of robotics vastly improves the capabilities of the surgeon controlling the robot while the minimally invasive procedure reduces patient recovery time and time in the hospital.

Surgery also involves staging with lymph node dissection, in which lymph nodes are removed from the pelvic area and sometimes also from the aorta (large blood vessel that carries blood away from the heart) so that lymphatic tissue samples can be checked under the microscope for signs of cancer spread.

Injection of the cervix with a fluorescent dye called indocyanine green at the start of surgery aids in more precise identification of lymph nodes that may carry cancer cells. A bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries) may also be performed, depending on your age and extent of disease. If endometrial cancer is diagnosed early, surgical removal alone may cure endometrial cancer.

What to Expect After Surgery

While uterine surgery aims to resolve cancerous conditions, there are additional concerns that are common related to major surgery in the lower abdomen. After surgery for uterine cancer, patients can expect a period of recovery and follow-up care:

• Hospital Stay: Most patients stay in the hospital for 1-4 days, depending on the type of surgery and their recovery speed.
• Pain Management: Pain is common after surgery, and pain relief will be provided through medications. The level of pain varies based on the type of surgery and individual pain tolerance2.
• Wound Care: Light vaginal bleeding is normal and should stop within 2 weeks. Proper wound care is essential to prevent infection2.
• Blood Clot Prevention: Patients may receive blood thinners to reduce the risk of blood clots. Compression stockings may also be recommended2.
• Constipation Management: Medications used during and after surgery can cause constipation, so dietary adjustments and medications may be needed to manage this.
• Follow-Up Appointments: Regular follow-up visits are crucial to monitor for any signs of recurrence. These visits may include physical exams, blood tests, and imaging studies3.
• Emotional Support: Recovery can be both physically and emotionally challenging. Support from healthcare providers, family, and friends is important for a smooth recovery.

Radiation Therapy for Uterine Cancer

Radiation therapy, or radiotherapy, uses high-energy rays to target and kill cancer cells. Radiation can be used after surgery to eliminate any remaining cancer cells or as a primary treatment for those who cannot undergo surgery. External beam radiation and vaginal brachytherapy (internally delivered radiation) are common methods used to treat uterine cancer.

Chemotherapy for Uterine Cancer

After the doctor removes all the uterine cancer that can be identified at the time of surgery, some patients may require a combination of chemotherapy (drugs that are taken by mouth or injection) and radiationtherapy to kill any remaining cancer cells. This will depend on imaging findings, fertility preservation and aggressiveness of the disease. Chemotherapy and radiation given after surgery, to reduce the risk of cancer coming back, is called adjuvant therapy.

Chemotherapy involves the use of drugs to kill cancer cells or prevent them from replicating and growing. It is often used for advanced or recurrent uterine cancer and may be given orally or intravenously. Chemotherapy can be used alone or in combination with other treatments. Depending on the extent of the disease at the time of diagnosis, some patients may require chemotherapy and radiation prior to surgery, in order to shrink the tumor to an optimal size for complete surgical removal; this is called neoadjuvant therapy.

What are the types of chemotherapy treatments for uterine cancer?

Chemotherapy for uterine cancer can vary based on the type and stage of the cancer, as well as the patient’s overall health. Here are some common variations:

• Combination Chemotherapy: This involves using multiple drugs together to enhance effectiveness. Common combinations include carboplatin and paclitaxel, cisplatin and doxorubicin, and cisplatin and paclitaxel. These combinations are often used for advanced or recurrent cancers1.
• Single-Agent Chemotherapy: In some cases, a single drug may be used, especially if the patient cannot tolerate combination therapy. Drugs like doxorubicin and paclitaxel are commonly used as single agents.
• Targeted Chemotherapy: This approach uses drugs that specifically target cancer cells without affecting normal cells. For example, trastuzumab (Herceptin) may be used for cancers that are HER2 positive.
• Chemoradiation: This combines chemotherapy with radiation therapy to enhance the effectiveness of both treatments. It is often used for more aggressive cancers or those that have spread beyond the uterus1.
• Adjuvant Chemotherapy: This is given after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence. It is typically used for high-grade tumors or cancers that have spread to lymph nodes1.

Biological Targeted Therapy for Uterine Cancer

Targeted therapy uses drugs or other substances to specifically target cancer cells without affecting normal cells. These treatments focus on specific molecules involved in the growth and spread of cancer cells. For example, HER2 inhibitors and angiogenesis inhibitors are types of targeted therapies that can be used in the treatment of uterine cancer.

Immunomodulation

Immunotherapy helps the body’s immune system fight cancer. It can be used to boost the immune response against cancer cells or to target specific parts of the immune system. Checkpoint inhibitors and cancer vaccines are examples of immunotherapy that may be used in the treatment of uterine cancer.

Hormone Therapy for Uterine Cancer

Hormone therapy can be used to treat certain types of uterine cancer that are sensitive to hormones. This treatment involves using drugs to block the effects of estrogen or progesterone, which can help slow the growth of cancer cells. It is often used for advanced or recurrent cancers.

Fertility-Sparing Treatments

For younger women who wish to preserve their fertility, certain treatments may be considered. These may include hormonal therapy or other less invasive options, although they come with their own risks and require close monitoring.

Each treatment plan is personalized based on factors such as the stage of cancer, the patient’s overall health, and their treatment preferences. Consulting with a healthcare provider is essential to determine the most appropriate treatment approach.